Increased paediatric presentations of severe diabetic ketoacidosis in an Australian tertiary centre during the COVID‐19 pandemic

Lawrence, Christopher M; Seckold, Rowen; Smart, Carmel E.; King, Bruce R.; Howley, Peter; Feltrin, Rob; Smith, Tony; Roy, Rajeev; Lopez, P. E.

doi:10.1111/dme.14417

Cited by 92 publications

(130 citation statements)

References 10 publications

(11 reference statements)

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“…Although not statistically significant, there seems to be a trend toward a higher rate of DKA during the pandemic period in patients with newly diagnosed T1D as well (53.4% vs 38.7%, Table 1 ). This finding was also reported in recent studies from Germany, Italy, and Australia [ 2 – 4 ]. There were no differences in serum pH and bicarbonate levels, rates of severe DKA, and rates of ICU admissions between the two study periods.…”

Section: Discussionsupporting

confidence: 90%

Diabetic Ketoacidosis at Emergency Department Presentation During the First Months of the SARS-CoV-2 Pandemic in Israel: A Multicenter Cross-Sectional Study

et al. 2021

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Introduction We aimed to examine the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on diabetic ketoacidosis (DKA) rates in children with type 1 diabetes (T1D). Methods A retrospective cross-sectional study of 11 Israeli pediatric emergency departments (ED) was conducted. Children with T1D who attended the ED between March 1, 2020 and May 31, 2020 were compared with those who attended the ED between March 1, 2019 and May 31, 2019. Results Overall, 150 and 154 children with T1D attended the EDs during the 3-month study periods in 2020 and 2019, respectively. Among patients with established T1D, DKA rates significantly increased in 2020 compared to 2019 [38/64 (59.3%) vs 31/74 (41.9%); p < 0.043]. There was a non-statistically significant trend toward a higher rate of DKA in patients with newly diagnosed T1D [46/86 (53.4%) vs 31/80 (38.7%); p = 0.063]. No differences were observed in the rates of severe DKA in 2020 compared to 2019 among patients with established T1D [10/64 (15.6%) vs 6/74 (8.1%); p = 0.184], and newly diagnosed T1D [16/86 (18.6%) vs 14/80 (17.5%); p = 0.858]. No differences were observed in the rates of intensive care unit admissions in 2020 compared to 2019 among patients with established T1D [14/64 (21.8%) vs 14/74 (18.9%); p = 0.672], and newly diagnosed T1D [26/86 (30.2%) vs 21/80 (26.2%); p = 0.977]. Conclusions Increased rates of DKA in children with established T1D were observed during the first 3 months of the outbreak in Israel. The findings suggest that the severity of DKA at ED presentation in children with T1D was not influenced by the pandemic.

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Section: Discussionsupporting

confidence: 90%

Diabetic Ketoacidosis at Emergency Department Presentation During the First Months of the SARS-CoV-2 Pandemic in Israel: A Multicenter Cross-Sectional Study

et al. 2021

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“…As viral infections have been associated with increased reports of T1D, the putative relationship between SARS-CoV-2 infection and the incidence rates of T1D continues to receive scrutiny. Nevertheless, reports from several centers do not support an increased incidence of new-onset T1D comparing historical rates with those from the recent pandemic period ( Lawrence et al., 2021 ; Tittel et al., 2020 ). Analysis of incident diabetes rates reported by 216 German pediatric diabetes centers from March 13 to May 13 each year from 2011 to 2020 in children and adolescents <18 years of age revealed no relative increase in cases reported in 2020 ( Tittel et al., 2020 ).…”

Section: Ketonemia Ketoacidosis and Insulin Deficiencymentioning

confidence: 96%

Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning

2021

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“…Providers at the nine clinics included in our study expressed concerns about negative health impacts resulting from the care adaptations at their clinic and the COVID‐19 pandemic more broadly. Studies have substantiated their concerns that delayed care‐seeking might increase rate and severity of DKA 6‐8 . While providers in our study were concerned about negative impacts of telemedicine, the existing literature, while scarce, presents a divergent viewpoint.…”

Section: Discussionmentioning

confidence: 67%

Changes to care delivery at nine international pediatric diabetes clinics in response to the COVID ‐19 global pandemic

et al. 2021

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Background Pediatric diabetes clinics around the world rapidly adapted care in response to COVID‐19. We explored provider perceptions of care delivery adaptations and challenges for providers and patients across nine international pediatric diabetes clinics. Methods Providers in a quality improvement collaborative completed a questionnaire about clinic adaptations, including roles, care delivery methods, and provider and patient concerns and challenges. We employed a rapid analysis to identify main themes. Results Providers described adaptations within multiple domains of care delivery, including provider roles and workload, clinical encounter and team meeting format, care delivery platforms, self‐management technology education, and patient‐provider data sharing. Providers reported concerns about potential negative impacts on patients from COVID‐19 and the clinical adaptations it required, including fears related to telemedicine efficacy, blood glucose and insulin pump/pen data sharing, and delayed care‐seeking. Particular concern was expressed about already vulnerable patients. Simultaneously, providers reported 'silver linings' of adaptations that they perceived as having potential to inform care and self‐management recommendations going forward, including time‐saving clinic processes, telemedicine, lifestyle changes compelled by COVID‐19, and improvements to family and clinic staff literacy around data sharing. Conclusions Providers across diverse clinical settings reported care delivery adaptations in response to COVID‐19—particularly telemedicine processes—created challenges and opportunities to improve care quality and patient health. To develop quality care during COVID‐19, providers emphasized the importance of generating evidence about which in‐person or telemedicine processes were most beneficial for specific care scenarios, and incorporating the unique care needs of the most vulnerable patients.

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Increased paediatric presentations of severe diabetic ketoacidosis in an Australian tertiary centre during the COVID‐19 pandemic

Cited by 92 publications

References 10 publications

Diabetic Ketoacidosis at Emergency Department Presentation During the First Months of the SARS-CoV-2 Pandemic in Israel: A Multicenter Cross-Sectional Study

Diabetic Ketoacidosis at Emergency Department Presentation During the First Months of the SARS-CoV-2 Pandemic in Israel: A Multicenter Cross-Sectional Study

Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning

Changes to care delivery at nine international pediatric diabetes clinics in response to the COVID ‐19 global pandemic

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